Treatment Options: III. In Vitro Fertilization
Steven R. Bayer, Michael M. Alper, Alan S. Penzias in The Boston IVF Handbook of Infertility, 2017
In some cases of azoospermia, sperm are being produced but do not find their way to the ejaculate. This may be the result of an obstruction (e.g., previous vasectomy, infection), congenital absence of the vas deferens, or cases of severely impaired sperm production. In these cases, aspiration of epididymal sperm or testicular sperm by a urologist may be considered. In years past, the only way to aspirate epididymal sperm was via the microscopic epididymal sperm aspiration (MESA) procedure. This procedure is performed in the operating room under general anesthesia. More recently, the percutaneous epididymal sperm aspiration procedure has become more popular. It can be accomplished under local anesthesia in the office with a much shorter recuperation than the MESA procedure. If epididymal sperm aspiration does not produce viable sperm, then the urologist can resort to testicular sperm extraction. In all cases of sperm aspiration, the motility of the sample is quite poor; thus, the ICSI procedure must be performed. To accomplish this procedure, there must be coordination with the urologist and the IVF team. The sperm aspiration can be performed on the day of the oocyte recovery or before the IVF cycle and the samples are frozen.
Inflammation and spermatogenesis
C. Yan Cheng in Spermatogenesis, 2018
ASAs may be detected in serum, sperm, seminal plasma, and also in follicular fluid or cervicovaginal secretions in women. Patients with a clinical history of testis inflammation associated with damage frequently present high ASAs levels in spermatozoa and seminal plasma. As well, 40%–70% of vasectomized men and patients with congenital absence of the vas deferens18 develop antibodies to sperm antigens. ASAs IgG type present in seminal plasma interacts with sperm plasma membrane antigens, affecting sperm motility or inducing sperm agglutination,19 while ASAs IgA type detected in the sperm head interferes mainly with the fertilization process. The detection of autoantibodies against protein disulfide isomerase ER60, expressed in the developing acrosome, has been proposed as a tool for diagnosis of infertility associated to testicular inflammation.20
Preimplantation Genetic Testing and Reproductive Genetics from a Physician's Perspective
Darren K. Griffin, Gary L. Harton in Preimplantation Genetic Testing, 2020
Besides its application for excluding the risk of cystic fibrosis being passed to the next generation, CFTR gene testing is also important in the diagnosis of male infertility. Mutations can cause congenital absence of the vas deferens (bi- or unilateral), bilateral obstruction of the ductus ejaculatorius, or bilateral obstruction of the ductus epididymis. All men with idiopathic obstructive azoospermia should thus have their CFTR gene examined.
Incidental finding of a congenital unilateral absence of the vas deferens during robotic inguinal hernia repair: missing a crucial landmark. A case report
Published in Acta Chirurgica Belgica, 2023
Kim Pauwaert, Filip Muysoms, Maxime Dewulf
During inguinal hernia repair a clear understanding of the anatomy, including the identification of the vas deferens (VD), is a crucial step to perform a safe dissection and obtain a critical view of the myopectineal orifice (MPO) (Figure 1) [1]. A congenital absence of the vas deferens (CAVD) is a rare condition, and has been described in up to 1% of the inguinal hernia repairs in children [2]. To our knowledge, this has only recently been described once as a finding during totally extraperitoneal preperitoneal (TEP) inguinal hernia repair in an adult patient [3]. We report on a second case of congenital unilateral atresia of the vas deferens (CUAVD) encountered during a robotic-assisted transabdominal preperitoneal (TAPP) inguinal hernia repair. Furthermore, we aim to provide a clear overview of relevant literature stressing its clinical relevance, and make recommendations on further investigations and management in case of an incidental finding of CAVD during inguinal hernia repair. This case report has been reported in line with the SCARE Criteria [4]. Patients consent was obtained for publications.
A cross-sectional study of the genital duct and renal anomalies in Egyptian cases of congenital absence of the vas deferens
Published in Human Fertility, 2022
Taha AbdElnaser, Yasser Ibrahem Elkhiat, Hatem Mohamed El-Azizi, El Fatah, Mohamed Abd, Ahmed Mahmoud Elshibany, Sameh Fayek GamalEl Din
Congenital absence of the vas deferens (CAVD) is a relatively rare bilateral (CBAVD) or unilateral (CUAVD) anomaly that may contribute to male infertility. CBAVD is the most common cause of extra-testicular ductal system obstruction affecting about 1–2% of infertile males, 4–17% of males with azoospermia, and 25% of males with obstructive azoospermia (Mittal et al., 2017). However, the real prevalence of CUAVD is unclear, as some men with CUAVD may have normal fertility status and no symptoms (Akinsal et al., 2018). Each mesonephric duct (Wolffian duct) is the source of two physically isolated derivatives: the ipsilateral ureteral/renal system and most of the ipsilateral genital duct (Akinsal et al., 2018). Previous studies indicated that congenital absence of the male genital duct system could occur separately or in combination with renal agenesis or malformations (Esteves, 2016). CAVD is generally identified during the evaluation of infertility or as an accidental finding at the time of a surgical procedure of the urogenital zone, such as orchidopexy or vasectomy (Ong et al., 2017). CAVD can be unilateral or bilateral and partial or complete, and it can be associated with epididymal hypoplasia or other abnormalities including seminal vesicles and ejaculatory duct anomalies and cryptorchidism (Khan & Novell, 2001). Although CAVD is usually not difficult to diagnose, it may be missed due to a poor (or no) physical examination taking place. Renal agenesis is the most common renal anomaly that can be seen with CAVD (Salwan & Abdelrahman, 2017). Nevertheless, several publications documented many other associated anomalies including ectopic kidney, multicystic kidney, horseshoe kidney and malrotation of the solitary kidney (Salwan & Abdelrahman, 2017).
Related Knowledge Centers
- Azoospermia
- Cystic Fibrosis Transmembrane Conductance Regulator
- Spermatozoon
- Embryo
- Cystic Fibrosis
- Semen
- Vas Deferens
- Sex Organ
- Testicle
- Penis